title: Early initiation of toilet training for urine was associated with early urinary continence and does not appear to be associated with bladder dysfunction.
abstract: OBJECTIVE
  To report the relationship between the ages initiating toilet training for urinary continence (TTU) and bladder function in healthy kindergarteners.
  
  
  METHODS
  In 3 years, we evaluated urinary continence status and bladder function in 318 healthy kindergarteners. Children with congenital anomaly, neurological disorder, or developmental disability were excluded. A parent completed the questionnaire including the age at initiation and the duration of TTU, the current status of daytime and nighttime continence, the age of attaining daytime and nighttime continence, frequency of defecation and Bristol Stool Scale. All children underwent uroflowmetry and post-void residual urine (PVR) examinations.
  
  
  RESULTS
  Finally, 235 respondents (106 boys/129 girls, mean age = 4.8 ± 0.9 years) were eligible for analysis. The mean age initiating TTU was 24.4 ± 8.4 months (range: 1-52 months). Girls started TTU earlier than boys (23.3 months vs. 25.7 months, P = 0.03). Children started daytime TTU earlier (≤ 18, 19-24, and >24 months, N = 66, 71, and 98, respectively) was associated with earlier attainment of both daytime and nighttime continence (correlation coefficient = 0.60 and 0.31, respectively, P < 0.01). Children started nighttime TTU earlier (<30 months vs. ≥ 30 months) was associated with early attainment of nighttime continence and lower rate of enuresis (14.3% vs. 33.3%, P < 0.01). The prevalence rate of repeat abnormal uroflow patterns and repeat elevated PVR (>20 ml) was not different between early and late TTU.
  
  
  CONCLUSIONS
  Early toilet training for urine was associated with early attainment of both daytime and nighttime urinary continence, and does not appear to be associated with bladder dysfunction.
authors.affiliation: Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, New Taipei, Taiwan.
authors.forename: Stephen Shei-Dei
authors.initials: SS
authors.lastname: Yang
authors.forename: Lu-Lu
authors.initials: LL
authors.lastname: Zhao
authors.forename: Shang-Jen
authors.initials: SJ
authors.lastname: Chang
mesh_terms: D000367:Age Factors; D016009:Chi-Square Distribution; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013624:Taiwan; D014039:Toilet Training; D001743:Urinary Bladder / Q000294:innervation*; D001745:Urinary Bladder Diseases / Q000209:etiology* / Q000503:physiopathology; D014554:Urination; D014563:Urodynamics